Individual
MISS SUSAN LYNN MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPC
Contact information
Practice address
2277 SWANSON AVE., SUITE B, LAKE HAVASU CITY, AZ 86403
(928) 854-0110
(928) 854-0112
Mailing address
P.O. BOX 1746, LAKE HAVASU CITY, AZ 86405
(928) 854-0110
(928) 854-0112
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LPC-13205
AZ
101YP2500X
Professional Counselor
Primary
LPC-13205
AZ
Other
Enumeration date
04/07/2009
Last updated
10/05/2010
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